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- W2047885038 abstract "Objective : The aim of this study was to review the results of dynamic pituitary testing in patients presenting with fatigue. Methods : We reviewed clinical histories and insulin tolerance test (ITT) results of 59 patients who presented with fatigue and other symptoms of glucocorticoid insufficiency over a 4-year period. All patients referred for ITT had an early-morning cortisol level of <400 nM and a low or normal ACTH level. Results : Peak cortisol and GH responses following insulin-induced hypoglycaemia were normal in only seven patients (12%). Median age of the remaining 52 patients was 47 years (range, 17–67 years); all but five were female. Common presenting symptoms were neuroglycopaenia ( n = 47), depression ( n = 37), arthralgia and myalgia ( n = 28), weight gain ( n = 25), weight loss ( n = 9), postural dizziness ( n = 15) and headaches ( n = 13). Other medical history included autoimmune disease ( n = 20; particularly Hashimoto’s thyroiditis, Graves’ disease and coeliac disease), postpartum ( n = 8) and gastrointestinal ( n = 2) haemorrhage and hyperprolactinaemia ( n = 13). 31 subjects had peak cortisol levels of <500 nM (suggestive of ACTH deficiency; 18 of whom had levels < 400 nM) and a further six had indeterminate results (500–550 nM). The remaining 15 subjects had normal cortisol responses (median 654 nM; range, 553–1062 nM) but had low GH levels following hypoglycaemic stimulation (5.9 mU/l; 3–11.6 mU/l). Conclusion : Our results suggest that patients presenting with fatigue and symptoms suggestive of hypocortisolism should be considered for screening for secondary adrenal insufficiency, particularly in the presence of autoimmune disease or a history of postpartum or gastrointestinal haemorrhage. Whether physiological glucocorticoid replacement improves symptoms in this patient group is yet to be established." @default.
- W2047885038 created "2016-06-24" @default.
- W2047885038 creator A5001212969 @default.
- W2047885038 creator A5072557977 @default.
- W2047885038 date "2006-01-01" @default.
- W2047885038 modified "2023-10-17" @default.
- W2047885038 title "Evaluation of pituitary function in the fatigued patient: a review of 59 cases" @default.
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- W2047885038 doi "https://doi.org/10.1530/eje.1.02010" @default.
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